Provider Demographics
NPI:1598828733
Name:BUSCAGLIA, ANTHONY LOUIS (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LOUIS
Last Name:BUSCAGLIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 MAJESTIC WOODS DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1174
Mailing Address - Country:US
Mailing Address - Phone:716-430-0094
Mailing Address - Fax:
Practice Address - Street 1:5430 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6648
Practice Address - Country:US
Practice Address - Phone:716-204-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105905207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02208506Medicaid